Significant Items In The House And Senate Appropriations Committee Report

Alzheimer’s Disease – The number of Americans with Alzheimer’s—4.5 million today—will increase to between 11.2 million and 16 million by 2050. Within a decade, total annual Medicare costs for people with Alzheimer’s will increase by almost 55 percent to nearly $50 billion. The Committee notes that rapid advances in basic science are helping to identify multiple targets for therapies that may help slow or halt the progression of Alzheimer’s disease. Before these promising advances can be put to use preventing or treating the disease, they must be tested and validated in controlled clinical trials. The Committee encourages NIA to launch simultaneous clinical trials on therapies it determines to be most promising. The Committee also encourages NIA to work collaboratively with other institutes and the CDC to educate Americans about the ways they can maintain their brain as they age (p. 90).

Action taken or to be taken

The NIA is taking a multi-pronged approach to developing an intervention to treat Alzheimer’s disease (AD) that pursues both behavioral and pharmacological interventions and, in the case of the latter, approaches a variety of suspected disease mechanisms simultaneously. The NIA has more than two dozen clinical trials investigating non-behavioral interventions for AD or related cognitive impairment. Trials currently enrolling patients include studies of: the non-steroidal anti-inflammatory medications naproxen and celecoxib to delay or prevent the onset of AD and age-related cognitive decline; Simvastatin®, a cholesterol lowering drug or statin, to test whether using a cholesterol lowering medication can slow disease progress in people with mild to moderate AD; selenium and/or vitamin E supplements to prevent memory loss and dementia, such as AD (an addition to the NCI prevention trial on prostate cancer); high-dose folate (folic acid), vitamin B6, and vitamin B12 supplementation to determine if reduction of homocysteine levels will slow the rate of cognitive decline in AD; valproate (an anticonvulsant) to delay the emergence of agitation and/or psychosis in persons with probable AD; vitamin E to slow the rate of cognitive/functional decline or development of AD in older persons with Down syndrome; huperzine A, a natural cholinesterase inhibitor with antioxidant and neuroprotective properties derived from the Chinese herb Huperzia serrata, to improve cognitive function in individuals with AD; and nicotine, using patches, to improve or delay the progression of symptoms in mild cognitive impairment.

The NIA continues to work collaboratively with other institutes, federal agencies, and private and professional organizations to support research and disseminate information on ways to maintain a healthy brain as one ages. The Cognitive and Emotional Health Project (CEHP) is a joint venture of three Institutes—NIA, NIMH, and NINDS; the overarching goal is to determine how cognitive and emotional health can be maintained and enhanced as people age, by assessing the state of the science on various determinants of adult cognitive and emotional health, and by promoting research to accelerate the pace of scientific advances. In 2004, the Alzheimer's Association launched a national campaign about AD, which includes a program urging people to Maintain Your Brain. This program is based on the best available science about brain health, which continues to emerge from studies supported by the NIA and other NIH institutes. The healthy lifestyles and nutrition emphasized in the “Maintain your Brain” program are also part of the health promotion program of the CDC on aging and elderly health, which includes the National Blueprint: Increasing Physical Activity Among Adults Aged 50 and Older. The NIA participated in the National Blueprint Steering Committee, and will continue to pursue opportunities for CDC collaboration on educational activities about ways to maintain a healthy brain.

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Down syndrome – Research has shown that many people with Down syndrome develop the neuropathological findings of Alzheimer’s disease, and that many go on in later life to show cognitive decline. The Committee encourages NIA to study the connection between Alzheimer's disease and Down syndrome and to work closely with NINDS, NICHD, NIMH and NHGRI to establish an initiative to support Down syndrome research on improving cognition and preventing early dementia through biomedical treatments. (p. 90)

Action taken or to be taken

Down Syndrome is due to trisomy (three copies) of chromosome 21 and involves misexpression of hundreds of genes. Recent work in Down syndrome mouse models suggests that certain individual genes on chromosome 21 are particularly critical to producing the overall phenotype. One of these genes involves amyloid precursor protein (APP), which is of particular interest to NIA, since amyloid plaques (one of the pathological hallmarks of Alzheimer's disease) are formed through the accumulation and aggregation of beta-amyloid peptides derived from APP.

The NIA is currently supporting two clinical trials addressing Down syndrome. One is a multi-national trial of vitamin E in older Down syndrome individuals to evaluate cognitive and functional changes. The second is a pilot trial of the combination of vitamin E/vitamin C/alpha-lipoic acid in older Down syndrome individuals to determine whether certain cognitive measure are improved with the intervention.

The NIA is also coordinating with NINDS, which is planning a workshop to discuss recent findings and explore the basic biology of Down syndrome and begin to identify some potential therapeutic targets. The workshop is aimed at identifying such targets or at establishing what knowledge or technical barriers need to be overcome in order to advance toward this goal. Quite a few specific synaptic defects have now been identified in Down syndrome patients and model mice, including APP toxicity. In addition, it is hoped that the workshop will help attract new researchers with basic neuroscience background into the study of Down syndrome. The NIA will work closely with other institutes, including NICHD, NIMH, and NHGRI, when new initiatives are developed.

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End-of-life/palliative care – The Committee encourages NIA to expand research, implementation of insights in practice, and training programs, aiming to understand the mechanisms of disability and suffering in fatal chronic illness and to prevent and relieve that disability and suffering, particularly with respect to pain management (p. 90).

Action taken or to be taken

Understanding the mechanisms of disability and suffering in both fatal and non-fatal chronic illnesses is a major area of research emphasis for the NIA, which supports a wide range of research and training to understand these mechanisms and to prevent and relieve related disability and suffering, particularly with respect to pain management.

As an example, a new study funded in the past year is examining the experiences of 250 older persons with advanced dementia during the end-stages of their disease and dying process, in the nursing home setting, about which there exists very little information. The goals of the CASCADE study—Choices, Attitudes, and Strategies for Care of Advanced Dementia at the End-of-Life—are to describe disease trajectory and clinical course; identify modifiable aspects of care associated with greater resident comfort, including during the dying process; and repeatedly assess substitute decision-maker (SDM) satisfaction with decision-making. As the first comprehensive, rigorous prospective investigation of nursing home residents with advanced dementia and their families, this study is designed to promote the understanding of patient suffering, prognoses, decision-making, and family burden in this population near the end-of-life.

A recent training award is to further career development and research that will inform and improve palliative care for older adults with chronic critical illness. The overall goals of this research training project are to assess palliative care needs of chronically critically ill older adults, including pain; evaluate the influence of unmet palliative needs on important clinical outcomes of chronic critical illness; and test targeted interventions to improve palliative care and associated outcomes of older adults with chronic critical illness.

Other recently funded studies in the wide-ranging NIA portfolio are examining the course and consequences of musculoskeletal pain in an older population; the effects of aging on brain responses to painful stimuli; the effects of age, race, and socioeconomic status on the ability to cope with arthritis; and the impact of pain on physical functioning in the elderly.

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Parkinson’s disease – The Committee encourages NIA to collaborate with NINDS in developing a greater understanding of the overlap in benefits that current research could provide to understanding both Alzheimer’s and Parkinson’s disease. The Committee applauds the significant investment by NIA in understanding the role of genes, including alpha-synuclein, in the causation and manifestation of Parkinson’s. Work of this nature is critical for better comprehension of the disease process, identification of potential pharmaceutical agents, improved diagnostic ability, especially during the nearly stages of the disease, and the development of accurate animal models (p. 91).

Action taken or to be taken

Several promising PD studies, some in response to FY2004 initiatives, are being supported by NIA. One project will be doing a genomic and genetic analysis of a drosophila transgenic that replicates the features of PD including age-dependent, progressive degeneration of dopaminergic neurons and movement disorder. Another will investigate biomarkers of PD that are present in human brain, and ventricular and spinal cerebrospinal fluid; a high throughput proteomic approach will be used to identify proteins unique to PD, PD progression, and development of cognitive deficits in PD.

Orolingual motor deficits—intermittent facial movements, initially involving the tongue and lips—are present in PD, and may be related to associated eating and swallowing dysfunction. One project has been examining the relationships between aging, orolingual motor function and the dopamine pathway in rats. Little is known about the mechanism of this motor function and this work represents a novel approach using an animal model.

Another innovative project will use the atomic force microscope to provide quantitative information on the magnitude of interactions between alpha-synuclein and lipids to determine the role of protein-lipid bilayer interactions in alpha-synculein aggregation.

A recent meeting, co-sponsored by the NIA and NINDS, on the overlap of Parkinson’s Dementia (PDD), Dementia with Lewy bodies (DLB) and Alzheimer’s disease (AD) resulted in a series of recommendations, including the establishment of workgroups with representation from both the Alzheimer’s Centers and the Udall Centers. These groups will address research issues such as assessment of the non-motor features in the dementias occurring in PDD, DLB and AD including visuo-spatial difficulties, fluctuating cognition, sleep disturbances and autonomic disturbances. Other groups will address neuropathological and biochemical profiling of the three dementias, family studies of PDD and LBD along with harmonization with family studies in AD, and identification of biomarkers and treatment targets for the three overlapping dementias.

Alzheimer’s Disease –Alzheimer’s is also having a corrosive effect in the private sector, costing U.S. businesses $61,000,000,000 in 2002, an amount equivalent to the net profits of the top 10 Fortune 500 companies. The Committee notes, however, that rapid advances in basic science are helping to identify multiple targets for therapies that may help slow or halt the progression of Alzheimer’s disease. Before these promising advances can be put to use preventing or treating the disease, they must be tested and validated in controlled clinical trials. Given the tremendous toll Alzheimer’s disease exacts in human suffering, health care costs and economic loss, the Committee strongly urges NIA to launch simultaneous clinical trials on therapies it determines to be most promising. The Committee also encourages NIA to work collaboratively with other institutes and the CDC to educate Americans about the ways they can maintain their brain as they age (p. 135).

Action taken or to be taken

Please refer to pages 32 of this document for NIA’s response to this significant item regarding Alzheimer’s disease.

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Alzheimer’s Research Caregiver, Education, and Training – The Committee recommends that the NIA establish cooperative working relationships with non-profit organizations dedicated to new approaches to care-giving for patients with Alzheimer’s disease, and to expand the level of resources made available for Alzheimer’s disease caregiver education, research, and training (p. 136).

Action taken or to be taken

The NIA has extensive cooperative working relationships with a variety of Alzheimer’s disease (AD) and Caregiving Groups including the Alzheimer’s Association, Alzheimer’s Foundation of America, National Family Caregiver Alliance, Family Caregivers Association, John Douglas French Alzheimer’s Association, American Health Assistance Foundation, and the Leeza Gibbons Memory Foundation and Leeza’s Place. The NIA also has strong connections with its network of AD Centers (ADCs) and shares findings in caregiver research with these organizations and with individual caregivers. Many of the groups have connections with the nearest ADC, and caregivers participate in research at the ADCs.

A series of caregiver pamphlets is provided free of charge to individuals and to the aforementioned organizations. They are available in English and in Spanish and include materials that have been developed through the ADC programs. Caregiver research funded by NIA has been highlighted in the most recent AD Progress Report, which is being mailed to these organizations, and additional copies are available to these groups to distribute through their own channels.

The NIA has an extensive program of both basic and applied research on caregiving. Recent projects have included a study showing that caregivers are at risk for adverse health outcomes even after their patient has been institutionalized, and a randomized controlled trial showing multiple benefits from exercise plus behavioral management for AD patients. NIA-funded research has demonstrated the utility of computer-based caregiving information and telephone reminders for caregivers to exercise. The NIA-funded Health and Retirement Study conducted a conference on “Older Families” in 2004, bringing together an interdisciplinary group of researchers working on topics such as parent care and stress, allocation of elder care responsibilities within families, and transitions to nursing homes.

The NIA and the National Institute on Nursing Research sponsor the Resources for Alzheimer’s Caregiver Health (REACH) program of interventions to improve the health and well-being of dementia caregivers. The first phase of REACH was designed to test feasibility of interventions; REACH II, now in progress, is examining the effectiveness of interventions incorporating the more successful elements of first phase trials. REACH includes training in caregiving skills and tailored coping strategies. Related research on how caregivers in different racial and ethnic groups differ in their perceived stress and rewards of the caregiving role, their use of formal in-home assistance, and in religious coping and participation is ongoing.

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Behavioral Research and Older Workers – The Committee encourages NIA to expand research on the needs of older workers. Since more baby boomers will be working well beyond the traditional age of retirement, more information is needed about the ways in which workplaces and workplace technology can be better designed to accommodate the needs of older workers (p. 136).

Action taken or to be taken

The NIA co-sponsored a National Research Council (NRC)/Institute of Medicine report on “Health and Safety Needs of Older Workers,” and sponsored an NRC report on “Technology for Adaptive Aging.” These reports, both published in 2004, are expected to guide further behavioral research on older workers.

NIA interest in work and aging is shown by continued funding of the Center for Research and Education for Technology (CREATE), with projects focused on the usability of technology by older individuals and on the potential for technology to support internet-based jobs for older individuals. NIA commissioned three review papers in 2004 on functional measures of work capacity, work complexity and cognitive function, and work, cognitive capacity and interaction with technological advances. An exploratory workshop focused on these issues is planned for summer 2005. Through an Intra-Agency Agreement, NIA also supports intramural research on the relationship between work complexity, work self-direction, and cognitive function in older populations.

The NIA is interested in research on work exposures, and the psychosocial and physical demands of a broad range of occupations to develop better estimates of the functional demands and benefits of those occupations. Research on the social and economic costs of workplace disease and injury also fits with NIA interests in the older worker.

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Bone Diseases – The Committee encourages NIA to increase research into the pathophysiology of osteoporosis, Paget’s disease and osteogenesis imperfecta. This research should include: genetics, the role of cell aging and altered metabolism, environmental and lifestyle factors, bone responsiveness to weight bearing, bone quality and fracture incidence, bone marrow changes, new agents to increase bone mass, the therapeutic use of new technology, and the comorbidity of metabolic bone diseases with chronic diseases of aging (p. 136).

Action taken or to be taken

The NIA supports a broad range of research on bone diseases related to aging, including research on hormonal changes, cellular changes, genetics, lifestyle factors, weight bearing and agents to increase bone mass. The NIA has an ongoing Program Announcement (PA), with NIAMS and NICHD, on “Aging Musculoskeletal and Skin Extracellular Matrix.” This PA was issued to stimulate research applications on age-related changes in bone matrix and on alterations in matrix with age-associated diseases such as Paget’s disease, as well as research on how alterations in activity levels or function affect matrix structure and function in the context of disabling conditions, which could include muscle atrophy, osteoporosis or osteogenesis imperfecta.

Several important results concerning bone mass have been reported recently. Novel studies have shown for the first time that thyroid stimulating hormone (TSH), the body’s regulator of thyroid activity, also has direct effects on bone turnover activity. This not only helps explain low bone mass (osteopenia) associated with hyperthyroidism (in which patients have very low levels of TSH), but opens an entirely new direction in investigations of bone regulation. In another study, bone was shown to be a target for the antidiabetic compound Rosiglitazone, which is used to treat type 2 diabetes, a common condition in the elderly. However, it also appears to pose a significant risk to skeletal health and may act to increase the tendency for marrow cells to form fat instead of build bone. In aging bone, the phenomenon of fat formation by cellular progenitors for bone and muscle may be one factor leading to imbalance of bone-building versus bone-destroying cells and consequent osteopenia. Investigation of key factors leading to formation of fat cells in aging musculoskeletal tissues and the effects on bone mass and muscle health, as well as effects on metabolism and overall health, are areas of NIA research interest.

Peak bone mineral density (BMD) appears to be a major determinant of risk of developing osteopenia and osteoporosis and has a large genetic component. Studies this year confirmed that peak BMD at the hip is linked to genetic loci on two chromosomes, and that peak BMD in vertebrae is linked to another chromosome. The vertebral locus corresponds to a similar chromosomal region that determines peak BMD in mice, and studies are ongoing to identify the specific genes involved. NIA is planning an initiative that will use existing data and specimens from other studies to identify factors that maintain BMD in older women as they age.

Although osteoporosis is often thought of as a disease of women, because they become particularly susceptible at menopause, it also affects high numbers of men. The estrogen receptor is known to be important in this process, and studies have now shown that men with higher levels of estradiol have higher BMD, and that specific genetic variations in the subtypes of estrogen receptor can modulate BMD. Additional studies in men characterized bone loss with age and potentially modifiable characteristics—increasing age, low body mass, weight loss, smoking and physical inactivity were all associated with bone loss in men.

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Action taken or to be taken

The NIA continues to value this important program, for which three meritorious applications were funded in FY 2004. The most recently reviewed applications were in response to the RFA for Claude D. Pepper Older Americans Independence Centers (OAICs), which was open to schools of nursing along with other institutions. Nursing faculty continue to be intimately involved in OAIC research, making important contributions to better our understanding of interventions to improve and maintain health and function among older persons. One of the currently funded OAICs is directed by a nurse with a faculty appointment in the school of nursing at the institution, and NIA will continue to welcome applications from schools of nursing for inclusion in the Claude D. Pepper Older American Independence Centers Program.

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Cognitive Research – The Committee has noted the results of the NIA-funded clinical trial, ACTIV, in which interventions to improve various aspects of cognition in older people were found to be effective, but did not generalize to improved cognitive performance overall. Understanding that changes in memory and cognition are troubling to older people and threaten their independence, the Committee encourages NIA to consider next steps in research to develop cognition-enhancing interventions and report back on additional efforts (p. 136).

Action taken or to be taken

Cognitive changes associated with increased age can become as great a disability as physical changes. NIA is interested in programs designed to intervene, slow-down, and reduce disability in these areas. This significant interest and investment in cognitive interventions is evidenced by the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE trial)—now in Phase II follow-up to the Phase I clinical trial interventionthat developed training for speed, memory, and reasoning. The training intervention was successful in raising performance, but the ultimate goal of assessing impact on instrumental activities of daily living requires further analysis of the degree to which cognitive training in specific domains can have an impact on disability, in domains that require a broad range of cognitive function. Preliminary results from ACTIVE suggest that conditions such as hypertension and diabetes do not influence the response to training, although individuals with those conditions start from lower levels. New results from the analysis of the ACTIVE trial suggest that training-related improvements in visual processing speed can improve attention, as it relates to driving and reduced crash risk.

Several other grants from NIA focus on cognitive intervention, including interventions involving self-monitoring of cognitive strategies; the Center for Translational Research on Aging and Mobility with a focus on driving, and the Center for Healthy Minds with a focus on social interaction as a context for cognitive intervention.

The NIA sponsored a Symposium on “Cognitive Training for Older Adults” in March 2004, which gathered 11 leading cognitive researchers to address: 1) the state of the art in development of cognitive interventions and are we ready to turn research findings into practice; 2) key research and methodological issues that the consumer, practitioner, and the researcher should be aware of when embracing the concept of cognitive intervention; and 3) how to judge the success of a cognitive intervention. Participants suggested that multilevel cognitive interventions involving exercise, social engagement, lifestyle management, and the combination of training and medications will be most promising. Articles from this symposium are to be published in a special issue on cognitive training and intervention in the Journal of Gerontology. A Program Announcement will be developed to encourage the development of new, innovative, and theoretically driven approaches to cognitive intervention programs.

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Demographic and Economic Research – The Committee once again commends the NIA for supporting demographic and economic research and, in particular, the NIA Demography of Aging Centers program. Since its inception 10 years ago, the program has supported invaluable research to enhance knowledge about the well being of older Americans—especially information about their health and socioeconomic status, including their income, savings, work, and retirement decisions. Researchers at these Centers have initiated critical surveys, such as the Health and Retirement Survey and the National Long-Term Care Survey, which have, for example, identified social and economic consequences of retirement and the decline in disability among older Americans, respectively. After a decade, the Centers are poised to make significant contributions on numerous policy issues confronting an aging society. The Demography Centers are also now in a unique position to collaborate with several of the NIA Roybal Centers program to help translate findings into interventions and improve quality of life for older people. Therefore, the Committee urges NIA to continue its strong support of the demography centers program (p. 137).

Action taken or to be taken

In 2004, the NIA awarded multi-year grants for Centers on Demography of Aging to nine continuing centers and four new ones; four of the centers are co-funded by the NIH Office of Behavioral and Social Sciences Research. The centers foster multi-disciplinary research on an array of issues especially relevant to the well-being of older Americans as the oldest of the “Baby Boom” generation approach retirement. The Health and Retirement Study has added a new cohort, representative of the older Baby Boomers, to the current wave of data collection, and will provide information on crucial questions of how their savings, retirement, and health care decisions differ from those of previous generations. The Centers’ research includes the age structure of populations; changes in the levels of disease and disability; the economic costs of disability; cost effectiveness of interventions; migration and geographic concentration of older people; decision-making about retirement; pensions and savings; the relationship between health and economic status; and health disparities by gender and race. A coordinating center will organize efforts to share research results widely and to involve researchers new to aging issues.

The National Long-Term Care Survey (NLTCS) went to the field in November 2004 for its sixth wave of data collection, and fieldwork is planned to be completed in February 2005. An NLTCS Conference was held in November 2004 in Washington, D.C. to present papers covering diverse topics and to introduce the NLTCS to a broader audience of researchers and policy makers. The NIA supports research following up on the NLTCS finding of declining disability at older ages, with studies of the specific causes and work on interventions to hasten disability decline. The six new Roybal Centers contribute in several ways to this effort, ranging from developing new tools for patient management and decision-making by older people to forecasting the effects of new technology on medical care and expenditures.

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Down Syndrome – Research has shown that all persons with Down syndrome develop the neuropathological findings of Alzheimer’s disease, and that many go on in later life to show cognitive decline. The Committee strongly urges NIA to increase funding to study the connection between Alzheimer’s disease and Down syndrome and to work closely with NINDS, NICHD, NIMH and NHGRI to establish a new, multi-year research initiative to fund Down syndrome research on improving cognition and preventing early dementia through biomedical treatments (p. 137).

Action taken or to be taken

Please refer to pages 33 of this document for NIA’s response to this significant item regarding Down syndrome.

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Hematology Research – The Committee remains interested in advancing research opportunities into blood disorders in the elderly population. The Committee is particularly concerned that the incidence and prevalence of anemia increases with age; after age 85, one quarter of the population is anemic. Research is needed to better understand the basic biology and adverse quality of life complications of anemia and other blood diseases in the elderly. The Committee is supportive of the ongoing collaboration between the American Society of Hematology and NIA, with the participation of NHLBI, NCI, and NIDDK, to develop a research agenda in this field (p. 137).

Action taken or to be taken

Anemia is the most frequently encountered hematological problem in geriatric practice. Over half the cases of anemia in older adults are without an identifiable cause, so there is no therapeutic intervention directed at an underlying condition. Anemia in the elderly is associated with reduced survival and increased risk of functional decline, acute coronary events, cognitive impairment, and drug complications. Projects are seeking to identify the mechanisms involved in anemia in the elderly and the effectiveness of treatment with erythropoietin (EPO), and to understand the underlying causes of anemia associated with chronic diseases and inflammation.

The American Society of Hematology (ASH) has worked closely with NIA and other institutes to establish a research agenda on anemia in the elderly. An ASH workshop on the “Clinical Implications of Anemia in the Elderly” was held in March 2004 to determine where gaps exist in current knowledge and to identify research opportunities and priorities; a report of this workshop will be published in the journal Blood in Spring 2005. Program staff from NIA, NHLBI, NCI and NIDDK participated in the ASH workshop and will work collaboratively to identify opportunities for initiatives to address research priorities within the missions of the institutes.

In October 2003, NIA issued two RFAs for stem cell research. Six of the funded applications explore hematopoietic (blood) stem cell (HSC) regulation and function in association with aging and aging-related conditions, and findings should begin to address the role of HSC dysfunction or responsiveness to EPO and changes in hematopoietic reserve associated with aging.

One likely cause of anemia in the elderly is early myelodysplasia, caused by the gradual accumulation of mutations in stem cells, which impairs their reproduction. The NHLBI has issued an RFA on “Myelodysplastic Syndrome (MDS): Seeking Cure Through Discovery on Pathogenesis and Disease Progression.” This initiative is expected to lead to new approaches to disease detection, treatment, and prevention. The NCI is also interested in MDS, and staff had a planning meeting at the December 2004 ASH annual meeting to discuss possible formation of an MDS Consortium to do clinical trials.

Anemia of chronic inflammation (ACI) is one of the most common forms of anemia in the aged, and may be a major contributor to the reduction in red cell mass that often accompanies aging. Although EPO is used to treat this anemia, the precise role and indications for erythropoietin in ACI remain to be established. The NIDDK is planning a new initiative to determine the pathophysiology of ACI and the inflammatory and genetic factors involved, and to develop diagnostic standards and a definitive therapy for ACI.

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Parkinson’s disease – The Committee encourages NIA to collaborate with NINDS in developing a greater understanding of the overlap in benefits that current research could provide to understanding both Alzheimer’s and Parkinson’s disease. The Committee applauds the significant investment by NIA in understanding the role of genes, including alpha-synuclein, in the causation and manifestation of Parkinson’s. Work of this nature is critical for better comprehension of the disease process, identification of potential pharmaceutical agents, improved diagnostic ability, especially during the nearly stages of the disease, and the development of accurate animal models (p. 137).

Action taken or to be taken

Please refer to pages 34 of this document for NIA’s response to this significant item regarding Parkinson’s disease.